The SHA 2011 statistical manual improves upon the original by strengthening the classifications to support production of more detailed results and by introducing new classifications that expand the scope of the analysis and provide a more comprehensive look at health expenditure flows. The purpose of this brief is to present the main features of the SHA 2011 framework as well as discuss the process of its implementation and, ultimately, institutionalization within routine government operations.
Follow the Money: Choosing the Most Appropriate Health Expenditure Tracking ToolHFG Project
Health spending data answer key questions such as who spends money on health, how resources for health are raised, who provides health goods and services, and which health goods and services are consumed. This data helps countries to understand how their health system is performing e.g. in terms of efficiency and equity. However, many health expenditure tracking tools exist and it can be difficult to know which tool best fits a country’s data needs.
This introductory guide provides information on five commonly used health expenditure tracking tools whose primary objective is to analyze health spending. It explains the similarities and differences between the five tools and clarifies their purposes, so countries are more informed about the tools available and are able to select the tool that best fits their needs. The guide is intended for low- and middle-income country chief planners and ministry of health officials who commission health expenditure tracking exercises. Health financing technicians may also find the guide useful for its explanation of the scopes of health expenditure tracking tools.
Botswana Health Accounts 2013-2014: Statistical ReportHFG Project
This methodological note provides an overview of the System of Health Accounts 2011 framework used for the 2013/14 health accounts (HA) exercise. It provides a record of data collection approaches and results, analytical steps taken, and assumptions made. This note is intended for government HA practitioners and researchers.
The Botswana 2013/14 HA exercise was conducted between July 2015 and September 2016. The study covers the 2013/14 fiscal year (1 April 2013–31 March 2014). In mid-2015, the HA team, with representation from the Government of Botswana, the Health Finance and Governance (HFG) project, and the World Health Organization (WHO), began primary and secondary data collection. Collected data were then compiled, cleaned, triangulated, and reviewed. Data were imported into the HA Production Tool (HAPT) and mapped to each of the System of Health Accounts (SHA) 2011 classifications. The results of the analysis were verified with the Health Financing Technical Working Group on 9 October 2016 and the Ministry of Health and Wellness (MoHW) management on 10 October 10 2016. Participants involved in the production and validation of the results, and recommended for future HA workshops, are listed in Annex A.
Understanding Health Accounts: A Primer for PolicymakersHFG Project
An update of the 2003 brief, this new primer provides an introduction to Health Accounts, the framework (System of Health Accounts 2011 or SHA 2011), and key steps involved in conducting Health Accounts exercises using SHA 2011 with particular emphasis on how policymakers can get involved to facilitate the process. The primer also includes country experiences illustrating show how Health Accounts data can be used for policy purposes, with specific attention to the importance of institutionalizing Health Accounts so that it may serve as an ongoing resource to policymakers.
Italian Regions are the accountable entities for healthcare policies: their activity is not limited to
policymaking but includes also management and financing of the Healthcare Public Utilities and services. A
first step will be the creation of a dataset of revenues and expenditures of the Healthcare sector. Second, the cofinancing policy will be analyzed using comparative grids of in/out-flows of each Region. Third, it will be taken
into account the regional fiscal coverage of the balance deficit. The sample is composed by the Italian Regions.
Last the analysis between our theoretical approach based on law and the real economic balance. Furthermore it
will be analyzed the National and Regional Healthcare System financing (in)-stability, highlighting current cash
flows, sources and investments using the “separation” of the Healthcare accounting items in the Balance Sheet.
Through chi-square test analysis and method of OLS the group of study look a possible relation be-tween
balance and respect of lea without finding a relationship. Latter, it will be represented an analysis of the National
Health Fund allocation to the Regions. It will be also conducted a critical analysis of the current allocation
formula and it will be proposed a simplified criterion of allocation.
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
This document discusses key topics in healthcare economics including health economics, demand and supply in healthcare markets, economic objectives in healthcare like efficiency and equity, concepts of economic efficiency applied to hospitals, healthcare expenditure trends globally and nationally, and priority areas for investing in health. It provides an overview of these essential healthcare economics concepts in 3 sentences or less.
Day 2 session 3 financing and governance v24_october2016 (1)mapc88812
The document discusses various aspects of financing for universal health coverage including:
1) Population coverage, health service coverage, and cost coverage are key dimensions of reforms for UHC.
2) In many low and middle income countries, high out-of-pocket expenditures negatively impact equity, access, and use of health services.
3) Reducing out-of-pocket costs requires addressing factors like irrational drug use and insufficient private sector regulation that contribute to cost escalation.
Tax-based systems finance healthcare through taxes collected from the entire population of taxpayers, allowing risks to be pooled across a large group. This subsidizes care for the poor and sick by transferring wealth from the rich and healthy. However, overuse of free services remains a problem. Pay-as-you-go user fee systems represent a market-based solution but fees disproportionately reduce access for the poor. Risk-based private insurance guarantees entitlement by collecting risk-adjusted premiums but rising costs can cause the poor and sick to lose coverage. Social health insurance compulsorily collects premiums from a broad base to ensure universal coverage unlike private systems. Donor funding significantly finances developing countries' healthcare through government systems or private organizations.
Follow the Money: Choosing the Most Appropriate Health Expenditure Tracking ToolHFG Project
Health spending data answer key questions such as who spends money on health, how resources for health are raised, who provides health goods and services, and which health goods and services are consumed. This data helps countries to understand how their health system is performing e.g. in terms of efficiency and equity. However, many health expenditure tracking tools exist and it can be difficult to know which tool best fits a country’s data needs.
This introductory guide provides information on five commonly used health expenditure tracking tools whose primary objective is to analyze health spending. It explains the similarities and differences between the five tools and clarifies their purposes, so countries are more informed about the tools available and are able to select the tool that best fits their needs. The guide is intended for low- and middle-income country chief planners and ministry of health officials who commission health expenditure tracking exercises. Health financing technicians may also find the guide useful for its explanation of the scopes of health expenditure tracking tools.
Botswana Health Accounts 2013-2014: Statistical ReportHFG Project
This methodological note provides an overview of the System of Health Accounts 2011 framework used for the 2013/14 health accounts (HA) exercise. It provides a record of data collection approaches and results, analytical steps taken, and assumptions made. This note is intended for government HA practitioners and researchers.
The Botswana 2013/14 HA exercise was conducted between July 2015 and September 2016. The study covers the 2013/14 fiscal year (1 April 2013–31 March 2014). In mid-2015, the HA team, with representation from the Government of Botswana, the Health Finance and Governance (HFG) project, and the World Health Organization (WHO), began primary and secondary data collection. Collected data were then compiled, cleaned, triangulated, and reviewed. Data were imported into the HA Production Tool (HAPT) and mapped to each of the System of Health Accounts (SHA) 2011 classifications. The results of the analysis were verified with the Health Financing Technical Working Group on 9 October 2016 and the Ministry of Health and Wellness (MoHW) management on 10 October 10 2016. Participants involved in the production and validation of the results, and recommended for future HA workshops, are listed in Annex A.
Understanding Health Accounts: A Primer for PolicymakersHFG Project
An update of the 2003 brief, this new primer provides an introduction to Health Accounts, the framework (System of Health Accounts 2011 or SHA 2011), and key steps involved in conducting Health Accounts exercises using SHA 2011 with particular emphasis on how policymakers can get involved to facilitate the process. The primer also includes country experiences illustrating show how Health Accounts data can be used for policy purposes, with specific attention to the importance of institutionalizing Health Accounts so that it may serve as an ongoing resource to policymakers.
Italian Regions are the accountable entities for healthcare policies: their activity is not limited to
policymaking but includes also management and financing of the Healthcare Public Utilities and services. A
first step will be the creation of a dataset of revenues and expenditures of the Healthcare sector. Second, the cofinancing policy will be analyzed using comparative grids of in/out-flows of each Region. Third, it will be taken
into account the regional fiscal coverage of the balance deficit. The sample is composed by the Italian Regions.
Last the analysis between our theoretical approach based on law and the real economic balance. Furthermore it
will be analyzed the National and Regional Healthcare System financing (in)-stability, highlighting current cash
flows, sources and investments using the “separation” of the Healthcare accounting items in the Balance Sheet.
Through chi-square test analysis and method of OLS the group of study look a possible relation be-tween
balance and respect of lea without finding a relationship. Latter, it will be represented an analysis of the National
Health Fund allocation to the Regions. It will be also conducted a critical analysis of the current allocation
formula and it will be proposed a simplified criterion of allocation.
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
This document discusses key topics in healthcare economics including health economics, demand and supply in healthcare markets, economic objectives in healthcare like efficiency and equity, concepts of economic efficiency applied to hospitals, healthcare expenditure trends globally and nationally, and priority areas for investing in health. It provides an overview of these essential healthcare economics concepts in 3 sentences or less.
Day 2 session 3 financing and governance v24_october2016 (1)mapc88812
The document discusses various aspects of financing for universal health coverage including:
1) Population coverage, health service coverage, and cost coverage are key dimensions of reforms for UHC.
2) In many low and middle income countries, high out-of-pocket expenditures negatively impact equity, access, and use of health services.
3) Reducing out-of-pocket costs requires addressing factors like irrational drug use and insufficient private sector regulation that contribute to cost escalation.
Tax-based systems finance healthcare through taxes collected from the entire population of taxpayers, allowing risks to be pooled across a large group. This subsidizes care for the poor and sick by transferring wealth from the rich and healthy. However, overuse of free services remains a problem. Pay-as-you-go user fee systems represent a market-based solution but fees disproportionately reduce access for the poor. Risk-based private insurance guarantees entitlement by collecting risk-adjusted premiums but rising costs can cause the poor and sick to lose coverage. Social health insurance compulsorily collects premiums from a broad base to ensure universal coverage unlike private systems. Donor funding significantly finances developing countries' healthcare through government systems or private organizations.
This document provides an overview of hospital revenues. The primary source of revenue for hospitals is operating revenue, which is generated from providing patient care services. Operating revenue is categorized as either gross or net patient service revenue. Gross patient service revenue is the total amount hospitals would receive if paid in full for all services, while net patient service revenue is the actual amount collected after deducting for charity care and contractual adjustments agreed to with insurance companies. Other sources of revenue include other operating revenue from non-patient care activities and gains/losses from peripheral business activities.
Improving Efficiency to Achieve Health System Goals in Botswana: Background P...HFG Project
Health outcomes have improved in Botswana over the last few decades. These successes have come at the same time as overall macroeconomic growth, with annual Gross Domestic Product (GDP) growth averaging around 6 percent between 2010 and 2015 (IMF 2015), and Human Development Index ranking above the regional average. These improvements originate in a strong health service delivery system. In 2008, Botswana’s public health system included 338 health posts and 277 health clinics, sufficient to ensure that at least 80 percent of the population has coverage of essential, high-impact services. Management of these services was initially done by the Ministry of Local Government but has been transferred to district health teams under the Ministry of Health (MOH). As of 2008, Botswana’s public health system also had 17 primary hospitals, 14 district hospitals, two referral hospitals, and one mental health hospital; these hospitals are managed by the central government.
Health Trends in the Middle East and North AfricaHFG Project
In the past several decades, countries in the Middle East and North Africa have made significant improvements in developing their health systems and improving the health status of their populations. However, the region continues to face substantial and diverse political, economic, social, and health challenges: a rise in the burden of noncommunicable diseases, ongoing conflicts in several countries, and refugee crises. To inform future USAID health investments in the Middle East and North Africa, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project and the Health Financing and Governance (HFG) project conducted an analysis of the private health sector and the health financing landscape from January 2017 to April 2018. The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen.
The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
Introduction: We Need Reform; It’s Up To Us!
Health Care Costs
Lack of Insurance
We Have to Cover Everyone to Control Costs!
Politics of Reform
Obstacles to Reform
Reform Proposals: What’s On the Table
Single Payer: Keep Fighting
Keep Fighting: For Affordability, Abortion, Access
System of Health Accounts (2011) and Health Satellite Accounts (2005): Applic...HFG Project
As the production and use of health accounting data continue to spread, countries need to understand how the approaches – their methods and data applications – fit their context and policy needs. Health stakeholders, including data users and technical experts as well as data producers, should be informed about the characteristics common to all approaches as well as the relative value of each in answering policy relevant questions.
The purpose of this brief is to introduce non-technical policymakers and other stakeholders to two prominent health accounting approaches: the System of Health Accounts (SHA), developed by the Organization for Economic Cooperation and Development (OECD) and its partners, and the Health Satellite Accounts (HSA) developed by the World Health Organization’s Regional Office for the Americas (AMRO). The approaches are closely related to and must be understood in relation to the System of National Accounts (“National Accounts”), the international framework for analyzing economic information in a country. The SHA focuses on the health care goods and services consumed by a country’s population and illustrates the flows of resources used to purchase them, beginning with their financing origins. The HSA focuses on the production of those health care goods and services and replicates the content of the National Accounts for the health field, including the value added of health care service production and the interaction of health resource flows with the rest of the economy.
Namibia 2012-13 Health Accounts: Statistical ReportHFG Project
Resource Type: Brochure
Authors: Ministry of Health and Social Services, Republic of Namibia
Published: June 30, 2015
Resource Description:This Namibia 2012/13 HA was conducted between July 2014 and March 2015. Following the launch workshop in September 2014, the HA team, with representation from the Government of Namibia, the HFG Project, and the World Health Organization (WHO), began primary and secondary data collection. Collected data were then compiled, cleaned, triangulated, and reviewed. Data was imported into the HA Production Tool and mapped to each of the SHA 2011 classifications. The results of the analysis were verified with Ministry of Health and Social Services management at a validation meeting on March 10th, 2015.
The purpose of the HA exercise was to estimate the amount and flow of health spending in the Namibia health system. In addition to estimating general health expenditures, this analysis also looked closely at spending on priority diseases, the sustainability of financing in light of trends of decreasing donor funding, levels of risk pooling and contributions by private sector, and beneficiaries of health services. For more information on the policy questions driving the estimation as well as a report compiling findings and their policy implications, please see the HA report.
This methodological note provides an overview of the System of Health Accounts 2011 framework used for the 2012/13 Health Accounts (HA) estimation. It provides a record of data collection approaches and results, analytical steps taken and assumptions made. This note is intended for government HA practitioners and researchers.
The document defines health economics as the application of economic principles to the health care system. It discusses key concepts in health economics including supply and demand of health care, costs associated with health care like fixed vs variable costs, and methods of economic evaluation used in health care planning like cost-benefit analysis. The document also outlines factors that influence health expenditures like changing demographics and disease patterns, new technologies, and rising public expectations. Overall, the document provides a broad overview of the basic concepts and scope of health economics as a field of study.
Countdown to Health Reform
Congress is close to passing substantial health reform, with important incremental steps to expand coverage, improve quality, and begin to control costs
Many are misinformed or uninformed about the proposals.
This resource presents:
The Problems
Cost, Access, Quality
Financing, Organization, Delivery
Health Care and Health
Why Insurance Doesn’t Work
The Politics of Reform
The Proposals: House and Senate
Keep Fighting for Single Payer
Fix It and Pass It!
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
- Government health spending in India is very low at just over 1% of GDP, well below what is needed to meet the country's health needs. This has forced many people to rely on private healthcare, leading to high out-of-pocket costs that push many into poverty.
- Reforms are needed such as increasing public health spending to 3-5% of GDP, regulating the private sector, and implementing a universal health coverage program. However, challenges remain due to India's large population, infrastructure weaknesses, and need to balance fiscal priorities.
- Initiatives have been launched such as the National Rural Health Mission and health insurance programs, but more focus is needed on primary care, community participation, and direct
The United States spends the highest amount on health care per capita compared to other countries. Health care represents almost one-fifth of the U.S. economy and health care jobs are one of the fastest growing sectors. National health care spending can be examined based on categories of service, sources of funding, and types of insurance payers. In 2013, the U.S. spent over $3 trillion on health care, with hospital care, physician/clinical services, and prescription drugs representing the largest categories of spending. Employers and households are the primary contributors to national health expenditures.
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
The document summarizes China's 2009 medical reform plan and its implications. Key points include:
- The reform aims to benefit public welfare and establish universal healthcare coverage by 2020 through expanding medical insurance, improving rural healthcare, and reforming public hospitals.
- ¥850 billion will be invested from 2009-2011, focusing on expanding insurance coverage, building an essential drug system, and upgrading rural medical facilities.
- The reform could benefit private hospitals but challenges include implementing new public hospital funding systems and regulating drug prices.
- It presents opportunities for pharmaceutical and medical device companies in rural/lower-end markets but may reduce pricing power for drugs included on the essential drug list.
Labor is the largest component of hospital costs, representing nearly two-thirds of total expenses. Between 2004-2008, hospitals in Massachusetts hired over 11,000 additional full-time employees, with wages for registered nurses increasing by 50% over that period. Patient care supplies and other expenses, which make up 25% of total costs, grew 35% during those years. Capital-related expenses, including depreciation and interest, increased 23% as hospitals faced difficulties accessing capital. Payment shortfalls from government programs like Medicare and Medicaid, which account for over half of hospital revenues, increased significantly and hospitals relied more on payments from private insurers to make up the difference.
This document discusses health care financing in India. It defines health care financing as mobilizing and allocating funds for specific health services and payment mechanisms. India relies heavily on private out-of-pocket spending for health care, with only about 10% having health insurance. Major challenges include linking insurance to employment when most work is informal, and excluding many poor from coverage. Community-based financing models show promise in providing social inclusion and financial protection. The conclusion calls for recognizing the role of health economists and addressing health financing within broader governance, economic, educational, and social contexts.
Essential Package of Health Services Country Snapshot: IndonesiaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Strengthening Primary Care as the Foundation of JKNHFG Project
Central to the vision of JKN and the Government of Indonesia’s commitment to enhancing the health of all of its citizens is strengthening the role of primary care to prevent, treat and manage health conditions. How it is working, what the challenges are, and where might changes to regulations or operationalization of JKN contribute to strengthening the system so that JKN can achieve its goals. This brief focuses on JKN regulations at the primary care level, and shares insights into whether regulations are effective and how they are being implemented in a range of Indonesian contexts.
This document provides an overview of hospital revenues. The primary source of revenue for hospitals is operating revenue, which is generated from providing patient care services. Operating revenue is categorized as either gross or net patient service revenue. Gross patient service revenue is the total amount hospitals would receive if paid in full for all services, while net patient service revenue is the actual amount collected after deducting for charity care and contractual adjustments agreed to with insurance companies. Other sources of revenue include other operating revenue from non-patient care activities and gains/losses from peripheral business activities.
Improving Efficiency to Achieve Health System Goals in Botswana: Background P...HFG Project
Health outcomes have improved in Botswana over the last few decades. These successes have come at the same time as overall macroeconomic growth, with annual Gross Domestic Product (GDP) growth averaging around 6 percent between 2010 and 2015 (IMF 2015), and Human Development Index ranking above the regional average. These improvements originate in a strong health service delivery system. In 2008, Botswana’s public health system included 338 health posts and 277 health clinics, sufficient to ensure that at least 80 percent of the population has coverage of essential, high-impact services. Management of these services was initially done by the Ministry of Local Government but has been transferred to district health teams under the Ministry of Health (MOH). As of 2008, Botswana’s public health system also had 17 primary hospitals, 14 district hospitals, two referral hospitals, and one mental health hospital; these hospitals are managed by the central government.
Health Trends in the Middle East and North AfricaHFG Project
In the past several decades, countries in the Middle East and North Africa have made significant improvements in developing their health systems and improving the health status of their populations. However, the region continues to face substantial and diverse political, economic, social, and health challenges: a rise in the burden of noncommunicable diseases, ongoing conflicts in several countries, and refugee crises. To inform future USAID health investments in the Middle East and North Africa, the Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project and the Health Financing and Governance (HFG) project conducted an analysis of the private health sector and the health financing landscape from January 2017 to April 2018. The countries included in this analysis are Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Syria, Tunisia, the West Bank and Gaza, and Yemen.
The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
Introduction: We Need Reform; It’s Up To Us!
Health Care Costs
Lack of Insurance
We Have to Cover Everyone to Control Costs!
Politics of Reform
Obstacles to Reform
Reform Proposals: What’s On the Table
Single Payer: Keep Fighting
Keep Fighting: For Affordability, Abortion, Access
System of Health Accounts (2011) and Health Satellite Accounts (2005): Applic...HFG Project
As the production and use of health accounting data continue to spread, countries need to understand how the approaches – their methods and data applications – fit their context and policy needs. Health stakeholders, including data users and technical experts as well as data producers, should be informed about the characteristics common to all approaches as well as the relative value of each in answering policy relevant questions.
The purpose of this brief is to introduce non-technical policymakers and other stakeholders to two prominent health accounting approaches: the System of Health Accounts (SHA), developed by the Organization for Economic Cooperation and Development (OECD) and its partners, and the Health Satellite Accounts (HSA) developed by the World Health Organization’s Regional Office for the Americas (AMRO). The approaches are closely related to and must be understood in relation to the System of National Accounts (“National Accounts”), the international framework for analyzing economic information in a country. The SHA focuses on the health care goods and services consumed by a country’s population and illustrates the flows of resources used to purchase them, beginning with their financing origins. The HSA focuses on the production of those health care goods and services and replicates the content of the National Accounts for the health field, including the value added of health care service production and the interaction of health resource flows with the rest of the economy.
Namibia 2012-13 Health Accounts: Statistical ReportHFG Project
Resource Type: Brochure
Authors: Ministry of Health and Social Services, Republic of Namibia
Published: June 30, 2015
Resource Description:This Namibia 2012/13 HA was conducted between July 2014 and March 2015. Following the launch workshop in September 2014, the HA team, with representation from the Government of Namibia, the HFG Project, and the World Health Organization (WHO), began primary and secondary data collection. Collected data were then compiled, cleaned, triangulated, and reviewed. Data was imported into the HA Production Tool and mapped to each of the SHA 2011 classifications. The results of the analysis were verified with Ministry of Health and Social Services management at a validation meeting on March 10th, 2015.
The purpose of the HA exercise was to estimate the amount and flow of health spending in the Namibia health system. In addition to estimating general health expenditures, this analysis also looked closely at spending on priority diseases, the sustainability of financing in light of trends of decreasing donor funding, levels of risk pooling and contributions by private sector, and beneficiaries of health services. For more information on the policy questions driving the estimation as well as a report compiling findings and their policy implications, please see the HA report.
This methodological note provides an overview of the System of Health Accounts 2011 framework used for the 2012/13 Health Accounts (HA) estimation. It provides a record of data collection approaches and results, analytical steps taken and assumptions made. This note is intended for government HA practitioners and researchers.
The document defines health economics as the application of economic principles to the health care system. It discusses key concepts in health economics including supply and demand of health care, costs associated with health care like fixed vs variable costs, and methods of economic evaluation used in health care planning like cost-benefit analysis. The document also outlines factors that influence health expenditures like changing demographics and disease patterns, new technologies, and rising public expectations. Overall, the document provides a broad overview of the basic concepts and scope of health economics as a field of study.
Countdown to Health Reform
Congress is close to passing substantial health reform, with important incremental steps to expand coverage, improve quality, and begin to control costs
Many are misinformed or uninformed about the proposals.
This resource presents:
The Problems
Cost, Access, Quality
Financing, Organization, Delivery
Health Care and Health
Why Insurance Doesn’t Work
The Politics of Reform
The Proposals: House and Senate
Keep Fighting for Single Payer
Fix It and Pass It!
The document discusses health care financing in Myanmar. It outlines the goals of a health system to provide good health outcomes, responsiveness, and fairness in financing. It then describes the various methods of health care financing in Myanmar including tax-based public financing, user fees, social security benefits, out-of-pocket payments, donor funding, health insurance, and community-based health insurance. It notes that Myanmar aims to explore alternative financing systems to augment roles of other providers and strengthen universal coverage while protecting people from financial hardship due to illness.
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
- Government health spending in India is very low at just over 1% of GDP, well below what is needed to meet the country's health needs. This has forced many people to rely on private healthcare, leading to high out-of-pocket costs that push many into poverty.
- Reforms are needed such as increasing public health spending to 3-5% of GDP, regulating the private sector, and implementing a universal health coverage program. However, challenges remain due to India's large population, infrastructure weaknesses, and need to balance fiscal priorities.
- Initiatives have been launched such as the National Rural Health Mission and health insurance programs, but more focus is needed on primary care, community participation, and direct
The United States spends the highest amount on health care per capita compared to other countries. Health care represents almost one-fifth of the U.S. economy and health care jobs are one of the fastest growing sectors. National health care spending can be examined based on categories of service, sources of funding, and types of insurance payers. In 2013, the U.S. spent over $3 trillion on health care, with hospital care, physician/clinical services, and prescription drugs representing the largest categories of spending. Employers and households are the primary contributors to national health expenditures.
“Function of a health system concerned with the accumulation, mobilization and allocation of money to cover the health needs of the people, individually and collectively, in the health system.” (WHO)
Revenue collection :
Taxation-most equitable system of financing
Health insurance contributions
User pays (out of pocket, no reimbursement)
Donor funding/Grants
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
The document summarizes China's 2009 medical reform plan and its implications. Key points include:
- The reform aims to benefit public welfare and establish universal healthcare coverage by 2020 through expanding medical insurance, improving rural healthcare, and reforming public hospitals.
- ¥850 billion will be invested from 2009-2011, focusing on expanding insurance coverage, building an essential drug system, and upgrading rural medical facilities.
- The reform could benefit private hospitals but challenges include implementing new public hospital funding systems and regulating drug prices.
- It presents opportunities for pharmaceutical and medical device companies in rural/lower-end markets but may reduce pricing power for drugs included on the essential drug list.
Labor is the largest component of hospital costs, representing nearly two-thirds of total expenses. Between 2004-2008, hospitals in Massachusetts hired over 11,000 additional full-time employees, with wages for registered nurses increasing by 50% over that period. Patient care supplies and other expenses, which make up 25% of total costs, grew 35% during those years. Capital-related expenses, including depreciation and interest, increased 23% as hospitals faced difficulties accessing capital. Payment shortfalls from government programs like Medicare and Medicaid, which account for over half of hospital revenues, increased significantly and hospitals relied more on payments from private insurers to make up the difference.
This document discusses health care financing in India. It defines health care financing as mobilizing and allocating funds for specific health services and payment mechanisms. India relies heavily on private out-of-pocket spending for health care, with only about 10% having health insurance. Major challenges include linking insurance to employment when most work is informal, and excluding many poor from coverage. Community-based financing models show promise in providing social inclusion and financial protection. The conclusion calls for recognizing the role of health economists and addressing health financing within broader governance, economic, educational, and social contexts.
Essential Package of Health Services Country Snapshot: IndonesiaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Strengthening Primary Care as the Foundation of JKNHFG Project
Central to the vision of JKN and the Government of Indonesia’s commitment to enhancing the health of all of its citizens is strengthening the role of primary care to prevent, treat and manage health conditions. How it is working, what the challenges are, and where might changes to regulations or operationalization of JKN contribute to strengthening the system so that JKN can achieve its goals. This brief focuses on JKN regulations at the primary care level, and shares insights into whether regulations are effective and how they are being implemented in a range of Indonesian contexts.
The document discusses National Health Accounts (NHA) in Bangladesh. It provides definitions of NHA according to WHO as a systematic monitoring of health resource flows. It summarizes the Bangladesh NHA (BNHA) framework which incorporates financing agents and providers. Key results from BNHA show total health expenditure increasing from 1997 to 2007 with households contributing through out-of-pocket payments mostly for medicines. While GDP spending on health increased slightly over time, public spending remained around 1% of GDP.
Progress in Institutionalizing Health Accounts in Indonesia: Where Next?HFG Project
1) The Health Finance and Governance Project provided technical assistance to help institutionalize Health Accounts production in Indonesia led by the Ministry of Health's Center for Health Financing and Health Insurance (PPJK) and the University of Indonesia (UI).
2) With this support, PPJK and UI produced the 2015 and 2016 Health Accounts and PPJK has increased its leadership and capacity to produce future accounts.
3) Challenges remain around maintaining expertise, deepening stakeholder relationships, disseminating data quickly, refining data sources, and expanding work at the sub-national level, but progress has been made in establishing regular production and use of Health Accounts data for policymaking in Indonesia.
The document discusses health systems and financing. It begins by defining a health system as all actors, institutions, and resources that undertake health actions, with the primary intent of improving health. Not all policies that influence health are part of the health system. The document then discusses the goals of health systems, including improving health and ensuring financial contribution. It outlines the key functions of health systems as stewardship, financing, resource generation, and service delivery. The document emphasizes the importance of aligning financing with national health plans to avoid fragmentation. It also discusses concepts of coverage, effectiveness, and factors that influence health outcomes.
Follow the Money: Making the Most of Limited Health ResourcesHFG Project
Worldwide, health systems are being asked to do more with less. In many countries, donor funds have stagnated or are declining. This sharp decline could have broad implications for the health sector— particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. New and emerging threats, such as Zika and Ebola, are also testing weak and fragile health systems, such as those in Guinea and Liberia. And costly noncommunicable diseases, like diabetes and cancers, are on the rise in low- and middle-income countries (LMICs).
With the end of the MDGs and start of the new SDGS, momentum is growing for countries around the world to pursue Universal Health Coverage (UHC) reforms and to expand affordable access to health care services, without risk of financial hardship, while facing real resource constraints in the aftermath of the global economic crisis.
In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably.
Policymakers can influence public and private health spending to improve efficiency, quality, equity, and expand access to life-saving health services. To succeed, however, governments need evidence around their health financing landscape. More and more, policymakers are appreciating the value of health resource tracking –that is, a range of methods, data collection initiatives, and estimation tools aimed at measuring the flow of funds to and through the health system.
Follow the Money: Making the Most of Limited Health ResourcesHFG Project
Worldwide, health systems are being asked to do more with less. In many countries, donor funds have stagnated or are declining. This sharp decline could have broad implications for the health sector— particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. New and emerging threats, such as Zika and Ebola, are also testing weak and fragile health systems, such as those in Guinea and Liberia. And costly noncommunicable diseases, like diabetes and cancers, are on the rise in low- and middle-income countries (LMICs).
With the end of the MDGs and start of the new SDGS, momentum is growing for countries around the world to pursue Universal Health Coverage (UHC) reforms and to expand affordable access to health care services, without risk of financial hardship, while facing real resource constraints in the aftermath of the global economic crisis.
In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably.
National health accounts - Michael Müller, OECDOECD Governance
This presentation was made by Michael Müller, OECD, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
This document provides an overview of health systems strengthening. It defines key concepts including health systems, health system strengthening, and the four main functions of a health system: stewardship, financing, human and physical resources, and service delivery. It then discusses each function in more detail, including how policies and programs can influence health outcomes through strengthening different parts of the health system. The goal is to help organizations and implementers understand health systems and how their work can benefit from health systems approaches.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Exploring New Sources of Revenue for Health: Filling the GapHFG Project
This document summarizes a report on exploring new domestic sources of revenue for health systems in low- and middle-income countries. It outlines different innovative financing options countries have used, such as taxes on goods like soft drinks, lottery funds, and mobile phone taxes. These options have had varying levels of success, with taxation approaches often generating significant funds but also tradeoffs around burden on the poor. The report provides a framework for analyzing options based on criteria like effectiveness, equity and macroeconomic impact. It concludes innovative financing must be considered in the context of broader health system reforms and the goal is improving population health, not just raising money.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
Monitoring progress towards universal health coverage at country and global l...The Rockefeller Foundation
A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes.
This paper was written jointly by the World Health Organization (WHO) and The World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations.
Engaging Civil Society in Health Finance and Governance: A Guide for Practiti...HFG Project
Governments and international donor organizations increasingly acknowledge the role of civil society organizations (CSOs) in strengthening health systems. By facilitating dialogue between government and citizens on issues of health sector priorities, performance, and accountability, CSOs can help to improve health service delivery and contribute to evidence-based policy. Often, however, CSOs lack the skills and tools needed to engage other stakeholders in issues of health finance and governance.
HFG’s guide provides governments and donors practical advice on engaging civil society in health finance and governance in order to meet health sector objectives and to improve health outcomes. Our guide describes the potential and limitations of civil society engagement entry points and presents an array of tools that may be used to do so.
Focusing specifically on the health sector, the HFG Guide offers practitioners a range of tools from which to choose based on the environment they work in and the objectives they seek to achieve. The guide emphasizes approaches that foster collaboration between public health officials and civil society that can improve access to and the quality of health services, ultimately contributing to improved health outcomes. This guide also seeks to provide practical mechanisms for how civil society engagement may be achieved, at the national, subnational, and community levels.
A simple overview on heatlhcare costs and reasons why there is a global increase in the field. The presentation concentrates the Omani setting with a comparison to what is available in public reports.
Essential Package of Health Services Country Snapshot: RwandaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Essential Package of Health Services Country Snapshot Series: 24 Priority Cou...HFG Project
The document summarizes findings from analyzing essential packages of health services (EPHS) in 24 priority countries. Key findings include:
- 23 of 24 countries defined an EPHS, though specificity of packages varied. Most included the majority of priority reproductive and maternal health interventions.
- Countries delivered EPHS through community health workers and public facilities. Some used EPHS to standardize private sector provision.
- Governments addressed equity through EPHS-related policies on populations and financial protection, though mechanisms varied.
- Priority setting for EPHS appeared limited, with most listing all services rather than prioritizing based on resources. EPHS purposes also varied between guiding service delivery,
This document summarizes the Ontario Public Health Standards, which establish requirements for fundamental public health programs and services in Ontario. The standards outline expectations for boards of health, which are responsible for providing services that address determinants of health and the physical, mental, and emotional well-being of Ontarians. Boards of health must assess needs, plan, deliver, manage, and evaluate a variety of population-based programs. The standards cover topics like chronic disease prevention, infectious disease control, environmental health, emergency preparedness, and more.
Population health envisions sustaining all members of the community lascellesjaimie
Population health envisions sustaining all members of the community at their highest possible level of functioning, both for their individual happiness and for the collective community benefit. Achieving the vision helps the community as a whole with lower healthcare costs and a larger, stronger workforce. Success in population health is measured by residents’ ability to lead a productive life, their life expectance, the incidence of preventable diseases and premature death, and disease prevention indicators such as immunization rates and the ability or support services.
The purpose of healthcare organization participating in population health management is to use the healthcare organization as a vehicle to improve the health status of its community. Many leading not-for-profit healthcare organizations are committed to population health management.
Population health management
is different from
excellence in care
, moving from process to outcome as a corporate focus. the Affordable Care Act encourages the healthcare organizations to do so. It rewards eliminating unnecessary admissions. it requires a community benefit review every three years as part of the IRS Form 990 Schedule H Community Benefit Calculations in order to retain tax exemption for the not-for-profit status.
Aligned to ULO(s)
ULO1: Differentiate between population health and population health management (CLO 4,5)
ULO2: Distinguish between the roles of the diverse partners in implementation of population health management (CLO 4,5)
ULO3: Map out plans to control the leading health conditions in the United States in general and health facilities specifically (CLO 4,5)
ULO4: Create a community health promotion program to help your facility improve their community catchment health (CLO 4,5)
Directions
You are the Director of Population Health Department of a not-for-profit healthcare system. Your department has recently conducted the Community Needs Assessment, which indicated high incidence of diabetes in the community and high frequency of outpatient doctor visits and hospital readmissions among individuals with diabetes. In grouping of disease and prevention forecasts by prevention level and service program, the report indicated that diabetes falls under the secondary prevention level (early-stage identification and elimination of disease); and examples of prevention activities include screening and dietary management.
...
Similar to System of Health Accounts 2011: What is SHA 2011 and How Are SHA 2011 Data Produced and Used? (20)
This document outlines a training manual for a hospital costing workshop. It provides an agenda for the 3-day workshop covering topics like the fundamentals of costing, the MASH costing tool, and calculating unit costs. The workshop aims to teach participants how to conduct costing exercises to understand their hospital's costs and improve management. Sessions include introductions, an overview of costing concepts, the costing process, and a demonstration of the MASH tool which is an Excel-based framework for tracking and analyzing hospital resources, services, and costs.
Trinidad and Tobago 2015 Health Accounts - Main ReportHFG Project
This document summarizes the key findings of the 2015 health accounts report for Trinidad and Tobago. It finds that total health expenditure was 4.5 billion TT dollars in 2015, equivalent to 4.1% of GDP. The government financed 41% of health spending, while households financed 35% through direct out-of-pocket payments. Noncommunicable diseases accounted for the largest share of recurrent health spending at 42%. Out-of-pocket payments remain high, comprising over a third of total health expenditure. The report recommends strengthening government commitment to health financing, increasing risk pooling to reduce out-of-pocket spending, improving access to services, and institutionalizing ongoing health accounts estimations.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
Rivers State has a population of over 7 million people from various ethnic groups. The main occupations are fishing, farming, and trading. The state has high rates of tuberculosis, neonatal and under-5 mortality, and HIV prevalence. Key stakeholders in health include the Ministry of Health, Ministry of Finance, and various agencies. The USAID Health Finance and Governance project worked to increase domestic health financing through advocacy, establishing a health insurance scheme, and capacity building. These efforts led to increased health budgets, establishment of healthcare financing units, and improved sustainability of health financing in Rivers State.
ASSESSMENT OF RMNCH FUNCTIONALITY IN HEALTH FACILITIES IN BAUCHI STATE, NIGERIAHFG Project
This document summarizes an assessment of reproductive, maternal, newborn and child health (RMNCH) services in health facilities in Bauchi State, Nigeria. It found that infrastructure like electricity, water and toilets were lacking in many facilities. There were also shortages of skilled healthcare workers, especially midwives, and staff training. While many facilities offered antenatal care and immunizations, availability of emergency obstetric and newborn care and services like postnatal care and post-abortion care were more limited. Supplies of essential medicines, equipment and guidelines were also often inadequate. Community outreach was provided by some facilities but could be expanded.
BAUCHI STATE, NIGERIA PUBLIC EXPENDITURE REVIEW 2012-2016 HFG Project
This document summarizes a public expenditure review of health spending in Bauchi State, Nigeria from 2012 to 2016. It finds that while Bauchi State's health budget increased over this period, actual health spending lagged behind budgeted amounts. Specifically, health spending accounted for a small and declining share of the state's total budget and expenditure. The review recommends that Bauchi State increase and better target public health funding to improve health outcomes and progress toward universal health coverage goals.
HEALTH INSURANCE: PRICING REPORT FOR MINIMUM HEALTH BENEFITS PACKAGE, RIVERS ...HFG Project
This document provides a pricing report for a Minimum Health Benefit Package (MHBP) being developed by Rivers State government in Nigeria. It analyzes the cost of 6 scenarios for the package, including individual and household premiums, based on medical claims data from hospitals in Rivers State from 2014-2017. The recommended annual premiums range from N14,026 to N111,734 for individuals and N79,946 to N636,882 for households, depending on the benefits included and the percentage of the state's population covered. The report provides context on data sources and actuarial assumptions used to determine the premiums.
The document is an actuarial report for Kano State's contributory healthcare benefit package in Nigeria. It analyzes 4 scenarios for the package - a basic minimum package alone or plus HIV/AIDS, tuberculosis, or family planning services. The report finds that the estimated annual premium per individual would be between N12,180-N12,600 depending on the scenario, while the estimated annual premium per household of 6 would be between N73,081-N75,595. It provides these estimates by analyzing the state's population data, healthcare facilities, utilization rates, and costs to determine the risk premiums, administrative costs, marketing costs, and contingency margins for each scenario. The report recommends rounding the premium estimates and includes
Supplementary Actuarial Analysis of Tuberculosis, LAGOS STATE, NIGERIA HEALTH...HFG Project
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Causes Supporting Charity for Elderly PeopleSERUDS INDIA
Around 52% of the elder populations in India are living in poverty and poor health problems. In this technological world, they became very backward without having any knowledge about technology. So they’re dependent on working hard for their daily earnings, they’re physically very weak. Thus charity organizations are made to help and raise them and also to give them hope to live.
Donate Us:
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Sponsor a Child for Education & Food.pptxSERUDS INDIA
Every year there are many generous people across the world who wanna help needy children with everything they need. The statistics say that donations worth education and food for more than 500 million children get every year
Donate Us:
https://serudsindia.org/sponsor-a-child-india-2021-kurnool/
#donatefororphan, #donateforhomelesschildren, #childeducation, #ngochildeducation, #donateforeducation, #donatefoodforchildren, #foodforchildren, #donationforchildeducation, #sponsorforpoorchild, #sponsororphanage #sponsororphanchild, #donation, #education, #charity, #educationforchild, #seruds, #kurnool
Presentation by Rebecca Sachs and Joshua Varcie, analysts in CBO’s Health Analysis Division, at the 13th Annual Conference of the American Society of Health Economists.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
FT author
Amanda Chu
US Energy Reporter
PREMIUM
June 20 2024
Good morning and welcome back to Energy Source, coming to you from New York, where the city swelters in its first heatwave of the season.
Nearly 80 million people were under alerts in the US north-east and midwest yesterday as temperatures in some municipalities reached record highs in a test to the country’s rickety power grid.
In other news, the Financial Times has a new Big Read this morning on Russia’s grip on nuclear power. Despite sanctions on its economy, the Kremlin continues to be an unrivalled exporter of nuclear power plants, building more than half of all reactors under construction globally. Read how Moscow is using these projects to wield global influence.
Today’s Energy Source dives into the latest Statistical Review of World Energy, the industry’s annual stocktake of global energy consumption. The report was published for more than 70 years by BP before it was passed over to the Energy Institute last year. The oil major remains a contributor.
Data Drill looks at a new analysis from the World Bank showing gas flaring is at a four-year high.
Thanks for reading,
Amanda
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New report offers sobering view of the energy transition
Every year the Statistical Review of World Energy offers a behemoth of data on the state of the global energy market. This year’s findings highlight the world’s insatiable demand for energy and the need to speed up the pace of decarbonisation.
Here are our four main takeaways from this year’s report:
Fossil fuel consumption — and emissions — are at record highs
Countries burnt record amounts of oil and coal last year, sending global fossil fuel consumption and emissions to all-time highs, the Energy Institute reported. Oil demand grew 2.6 per cent, surpassing 100mn barrels per day for the first time.
Meanwhile, the share of fossil fuels in the energy mix declined slightly by half a percentage point, but still made up more than 81 per cent of consumption.
Presentation by Julie Topoleski, CBO’s Director of Labor, Income Security, and Long-Term Analysis, at the 16th Annual Meeting of the OECD Working Party of Parliamentary Budget Officials and Independent Fiscal Institutions.
System of Health Accounts 2011: What is SHA 2011 and How Are SHA 2011 Data Produced and Used?
1. System of Health Accounts 2011
What is SHA 2011 and
How Are SHA 2011 Data
Produced and Used?
Health resource tracking is the process of measuring health spending and the flow
of financial resources among health sector actors. Health resource tracking
is a vital component of health systems strengthening as it provides stakeholders
with information on the value of health care goods and services purchased and
patterns in the financing, provision, and consumption of health care resources.
The System of Health Accounts (SHA) is an internationally standardized
framework that systematically tracks the flow of expenditures in the health
system.The SHA is critical for improving governance and accountability at
the national and international levels of policy-making. First published in 2000
(OECD 2000), SHA was then adapted to the
developing-country context in a version of
the SHA called National Health Accounts
(NHA) (WHO et al 2003). Over 100
developing countries have completed NHA
estimations, many with support from USAID,
to inform health policy and measure health
system performance. Most recently, OECD,
EUROSTAT, andWHO produced an updated
version of the SHA (OECD et al. 2011).The
SHA 2011statistical manual improves upon
the original by strengthening the classifications
to support production of more detailed
results and by introducing new classifications
that expand the scope of the analysis and
provide a more comprehensive look at health
expenditure flows.The purpose of this brief is
to present the main features of the SHA 2011
framework as well as discuss the process of its implementation and, ultimately,
institutionalization within routine government operations.
Key Features and Components of
the SHA Framework
Completing Estimations with
SHA 2011
Institutionalizing SHA 2011
Key Differences between NHA
(based on SHA 2000) and
SHA 2011
Benefits of the Updated Framework
- SHA 2011
Inside
2. 2
Key Features and
Components of
the SHA Framework
International Standardization Allows for
Cross-Country Comparisons: The SHA
2011 is standardized for international application
through classifications that are comprehensive in
their inclusion of all entities, financing mechanisms,
providers, and types of health care goods and
services that occur globally.The SHA 2011 statistical
manual (OECD et al. 2011) provides detailed
discussion of these categories and classifications, as
well as the underlying concepts and principles that
define the framework.This manual ensures that
each country engaged in the estimation exercise
classifies country-specific flows in a uniform way and
produces comparable results.
ExpenditureTracking Provides an Accurate
Indicator of Consumption: The SHA 2011
framework uses expenditures to describe the
health system. Expenditures measure the value of
goods and services at the point of consumption in
monetary units. Compared with other monetary
units (e.g., commitments, disbursements, budgetary
projections, revenue), expenditures are preferred
for tracking past spending because they are closer
to the actual point of consumption and thus a more
accurate indicator of the value of that consumption.
For example, though a development partner might
commit to spending US$10 million to support a
country’s HIV program, a changing political landscape
in the partner country may cause the actual value
of funding disbursed to be less than originally
stated; or limitations in absorptive capacity in the
recipient country may cause the actual value of
funding allocated to various programs to be less
than budgeted. Focusing on expenditure allows for
another important policy application: the comparison
of actual to planned spending to increase
accountability and strengthen budgeting processes.
Functional,Time, and Space Boundaries
Contribute to Standardization: A central
concept to the SHA 2011 is that a specific
expenditure is classified based on the goods and
services consumed with it. Health expenditures
are defined as money spent with the purpose
of improving, maintaining, or preventing the
deterioration of individual or population health
status and to mitigate the consequences of ill health.
This “functional definition” of health care means
that the categories listing types of health care are
organized in terms of the type of care received (e.g.,
curative, rehabilitative, and preventive).The spending
captured in these categories covers all costs
incurred in the final consumption of the good or
service, including operational and on-the-job training
costs.This approach to health accounting is inclusive
of health spending from all sectors (public, private,
external) within the health system. By including all
sectors, the SHA 2011 allows countries to consider
the level of interaction and comparative importance
of the sectors at different stages of the resource
flows. Including all sectors also allows SHA 2011
results to answer critical questions about the burden
on, and behavior of, households in the health system.
In addition to defining health expenditures, the SHA
2011 also defines time and space boundaries, which
is essential to making the approach internationally
standardized.The SHA 2011 time boundary specifies
that each analysis covers a one-year period and
includes the value of the goods and services that
were consumed during that period.The time
boundary is necessary in making the distinction
between current and capital spending: SHA 2011
restricts core spending to only spending on health
care goods and services entirely consumed during
the one-year accounting period (“current” health
spending); investment in goods and services
whose value lasts beyond the accounting period
is considered “capital” spending and is tracked
separately.The SHA 2011 space boundary specifies
that each analysis covers one country and restricts
health care goods and services to those consumed
3. System of Health Accounts 2011 - What is SHA 2011 and How Are SHA 2011 Data Produced and Used? 3
by residents of the country, that is, citizens and
established foreign nationals.
Core and Extended Accounting Framework:
As Figure 1 shows, SHA 2011 tracks health
resources in magnitude and along their pathway
from origin to end use. SHA has at the core of its
framework three classifications: health care functions,
which show the types of health care consumed;
providers, which show who delivers health care
services; and financing schemes, which show how
goods and services consumed and provided are
financed. SeeTable 1 for more detail on these core
classifications.
In addition to these core classifications, the SHA
2011 framework proposes additional classifications
that are linked to the core classifications.These
additional classifications are beneficiaries, which
show health care consumption by population groups
(divided by age, disease burden, income quintile,
etc.); factors of provision, which show the inputs
used by providers to deliver health care services;
and revenues of financing schemes, which show the
sources of funding for each financing scheme.The
SHA statistical manual includes these classifications
as part of the “extended accounting framework,”
The manual also includes the capital formation
classification, which compiles investments by health
care providers, as part of the extended framework.
Table 2 provides more detail on the additional
classifications.
Organizing complex spending information into these
classifications allows the SHA 2011 to characterize
the financing and purchasing mechanisms associated
with health resource flows in the country while also
providing a snapshot view of the health resources at
Figure 1. SHA Tri-Axial Framework
OECD et al., 2011
4. 4
Financing
schemes
zz Definition: main types of financing arrangements through which people receive health care
zz Questions answered: “How are health resources managed and organized?” “To what extent are resources pooled”
zz Examples: Government programs run by the Ministry of Health, National AIDS Commission; voluntary
insurance
Health care
providers
zz Definition: organizations and actors that, either primarily or as part of the multiple activities in which they are
engaged, deliver health care
zz Questions answered: “What is the organizational structure that is characteristic of the provision of health care
within a country?” “Who provided the goods and services to consumers?”
zz Examples: Hospitals, clinics, health centers, pharmacies
Health care
functions
zz Definition: Types of health goods and services consumed and activities performed
zz Questions answered: “What types of health care goods and services were consumed?”
zz Examples: Curative care, information, education, and counseling programs, medical goods such as supplies and
pharmaceuticals, governance and health system administration (includes national-level surveys)
Table 1. Classifications under the Core Framework
Table 2. Classifications under the Extended Framework
Revenues
of financing
schemes
zz Definition: Types of revenue received or collected by financing schemes
zz Questions answered: “How much revenue is collected?” “In what ways was it collected?”
“From which institutional units are revenues raised for each financing scheme?”
zz Examples: Direct foreign financial transfers; voluntary prepayment from employers; transfers from the ministry of
finance to other governmental agencies
Financing agents zz Definition: Institutional units that manage health financing schemes
zz Questions answered: “Who manages the financing arrangements for raising revenue, pooling/managing resources,
and purchasing services?”
zz Examples: Ministry of Health, commercial insurance companies, international organizations
Factors of
provision
zz Definition: Types of inputs used in producing the goods and services or activities conducted inside the SHA 2011
“health” boundary
zz Questions answered: “What mix of production inputs do providers of health care goods and
services use?”
zz Examples: Wages, utilities, rent, materials, and services used
Beneficiary
characteristics
(age, gender,
socio-economic
group)
zz Definition: Characteristics of those who receive the health care goods and services or benefit from those activities
zz Questions answered: “What is the value of health care goods and services consumed by various population groups?”
zz Examples: Age, gender, socio-economic group
Beneficiary
characteristics:
(disease)
zz Definition: Characteristics of those who receive the health care goods and services or benefit from those activities
zz Questions answered: “What percent of total health resources went to Reproductive Health?” “What were the main
sources of funding for HIV?” “Who provided Malaria prevention services?”
zz Examples: Disease by ICD-10 classifications
Capital
formation and
related
zz Definition: Types of investments that health providers have made during the accounting period that are used for
more than one year in the production of health services
zz Questions answered: “What types of assets have providers acquired?”
zz Examples: Infrastructure, machinery, and equipment (capital formation); formal training, Research and
Development (related items)
5. System of Health Accounts 2011 - What is SHA 2011 and How Are SHA 2011 Data Produced and Used? 5
each stage of their journey. SHA 2011 results can
show how revenues are raised, how health funds are
managed or pooled, and how goods and services
are purchased, highlighting the movement of funding
from one stage (e.g., revenue raising) to the next
(e.g., managing and pooling). Stakeholders can then
focus on one dimension – for example, the sources
of health resources or the Revenues of Financing
Schemes dimension – to determine how dependent
a country’s health system is on external institutions.
Tri-axial accounting of health expenditures:
The SHA 2011 uses a tri-axial recording of
each transaction to enable understanding of
resource flows between financing, provision, and
consumption.This approach ensures that the value
of all health care goods and services consumed
equals the value of health care goods and services
provided and financed.
Tables 1 and 2 provide definitions, questions
answered, and examples for the dimensions, both
core and extended, that make up the SHA 2011
framework.
Completing Estimations with
SHA 2011
Completing resource tracking exercises in-country
according to the SHA 2011 framework typically has
four stages.The process is country-driven, though it
sometimes requires external assistance.The stages
are summarized in Figure 2 below.
Figure 2. Process for Completing SHA 2011 Estimations
Planning, Scoping, and Launch
A unit within the government (typically the Ministry of Health) identifies technical staff responsible for completing the exercise, and a steering committee
to manage the process and provide high-level input on the policy questions to be addressed. The technical staff and steering committee consult health
stakeholders from all sectors on the key questions that resource tracking can answer. With steering committee and stakeholder guidance, the technical team
can customize the SHA 2011 codes and define the parameters of the exercise (i.e., which extension dimensions to include).
Engage stakeholders
Establish technical team and
steering committee
Define parameters and questions;
create work plan
Data Collection
Countries can draw upon secondary data from the health information system and other sources if they are available. If not, countries can conduct primary data
collection for institutions (donors, NGOs, insurance companies, and employers). Even with primary data collection, technical teams may realize that surveyed
institutions do not have the quality of data or level of detail needed. Data gaps identified will need to be addressed in a standardized way. A major task is
collecting household data, ideally done through a national survey. Household data are typically collected every five years.
Gather secondary data Collect primary data
Data Analysis and Validation
Once data are collected, the technical team turns to data analysis, a process that involves mapping all health expenditures to their corresponding SHA codes
for each of the dimensions included in the exercise. This stage is often done as a workshop. The team will need to use other secondary data to define allocation
ratios for splitting some expenditures into units that match the SHA framework. The technical team should meet with the steering committee and stakeholders
to validate results and to identify and resolve any data gaps and conflicts. The technical team should produce final tables summarizing the results of the analysis
Review data and apply weights Map health expenditures to SHA codes at all dimensions
Report-Writing and Dissemination
Finally, the team disseminates “briefs” that summarize the main findings and policy implications. The team can also produce tailored dissemination products,
including PowerPoints, brochures, and additional policy briefs, for targeted audiences.
Present results of report to technical team Generate information products for wider consumption
6. 6
Institutionalizing SHA 2011
Though many lower- and middle-income countries
have conducted a single SHA or NHA estimation
to analyze their health expenditures, relatively few
countries produce them regularly. Producing SHA
on a routine basis is important to ensure that the
health expenditure information remains up-to-date
and relevant to policy discussions. It allows for more
powerful analyses, as data over time will illuminate
trends in health spending, and for more meaningful
application of results, as more stakeholders will be
aware of the results and how to use them effectively.
Producing SHA on a routine basis can also result
in higher quality data, as the systems for gathering
needed inputs and the technical capacity of the SHA
team will improve with each round of estimations.
The process of establishing SHA as an integral and
sustained part of government operations is called
“SHA Institutionalization.”
While desirable, institutionalizing SHA can be
technically and politically complex and can take
many years before the proper technical and
governance systems are in place. In response
to these challenges, international development
partners have developed strategies and tools to
facilitate the process. Examples include the Health
Accounts ProductionTool, which streamlines the
production process, and the AnalysisTool, which
automates basic analysis of results. International
development partners have also identified key
characteristics of institutionalized resource tracking
systems (presented inTable 3).Though the process
for institutionalizing SHA will also vary country
by country, countries can still reference these key
characteristics in order to strategize actionable
plans for moving forward.
Officially mandated The government recognizes the value of SHA estimations and provides an official mandate to
conduct SHA estimations on a regular basis.
Incorporated in
budgets
SHA is incorporated as an item in the government’s annual budget.
Housed in-country SHA is housed in a stable institution that will promote application of the results to policy.
Traditional locations include: the Ministry of Health, the Ministry of Finance, a central
statistical bureau, or a local university.
Proper team
capacity
The country SHA team has the capacity to plan, manage, and monitor the SHA estimation
process.
Stakeholders
engaged
A wide group of stakeholders and steering committee members are actively engaged in the
production, dissemination, and institutionalization processes relating to SHA.
Systematic data
collection
A systematic process for collecting necessary health expenditure data exists including, if possible,
incorporating SHA household survey questions into existing national surveys.
Coordination Mechanisms are in place to coordinate SHA estimations with other stakeholders and resource
tracking activities.
Reporting of results Results are analyzed, disseminated, and used by a wide range of stakeholders to inform relevant
policy discussions and increase system transparency.
Table 3. Key Characteristics of Institutionalized Resource Tracking Systems
7. System of Health Accounts 2011 - What is SHA 2011 and How Are SHA 2011 Data Produced and Used? 7
Key Differences between
NHA (based on SHA 2000)
and SHA 2011
Disease-specific SpendingTrackedThrough
“Global Burden of Disease” Classification:
Prior to 2011, countries used the “subaccount”
methodology to track spending in priority diseases
(e.g., HIV/AIDS) or health areas (e.g., Family
Planning). Subaccounts gathered more detailed
information on these subsectors and measured them
as a percentage of total spending on health in the
country. SHA 2011 has replaced subaccounts with
a comprehensive classification, Global Burden of
Disease (GBD), that is based on the International
Classification of Disease (ICD-10). Using GBD to
classify expenditures in the Beneficiary Dimension
with other characteristics (e.g., age, gender, and
socioeconomic status) will ultimately allow for more
policy application of interest to a wider group of
stakeholders.
“Health Financing Scheme” Dimension
Identifies How Funds are Managed: In the
NHA , the financing agent dimension answered
questions about who managed health resources as
they flowed from their origins to end use (providers
and functions). In SHA 2011, financing agents are
complemented with Health Financing Schemes (HF),
which answers how funds are managed. Health
Financing can also be defined as rules for satisfying
the three financing functions: raising revenue, pooling
and managing resources, and purchasing services.
“Current Health Spending” Represents
Spending on Final Consumption: NHA
produced the aggregateTotal Health Expenditure
(THE), which covered all health spending in a
country’s health system during the accounting period.
THE included spending on health care goods and
services entirely consumed during the accounting
period, as well as health system investments whose
value lasted beyond the accounting period.The
SHA 2011 separates these two types of spending,
using Current Health Expenditure (CHE) as a
new indicator. CHE represents only spending on
final consumption; capital spending is tracked and
aggregated separately.
8. DISCLAIMER
The author’s views expressed here
do not necessarily reflect the views
of the U.S.Agency for International
Development or the U.S. Government.
Abt Associates Inc.
www.abtassociates.com
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Suite 800 North, Bethesda, MD 20814
About HFG
A flagship project of USAID’s Office of
Health Systems, the Health Finance and
Governance (HFG) Project supports
its partners in low- and middle-income
countries to strengthen the health
finance and governance functions of
their health systems, expanding access
to life-saving health services.The HFG
project is a five-year (2012-2017) global
health project.To learn more, please visit
www.hfgproject.org.
The HFG project is a five-year
(2012-2017), $209 million global
project funded by the U.S.Agency for
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The HFG project is led by Abt
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Broad Branch Associates, Development
Alternatives Inc., Futures Institute,
Johns Hopkins Bloomberg School of
Public Health, Results for Development
Institute, RTI International, and Training
Resources Group, Inc.
September 2013
References
OECD. 2000. A System of Health Accounts.
OECD, Eurostat, and WHO. 2011. A System of Health Accounts 2011.
http://www.who.int/nha/sha_revision/sha_2011_final1.pdf
World Bank,WHO, USAID. 2003. Guide to producing national health accounts with special applications for
low-income and middle-income countries. http://www.who.int/nha/docs/English_PG.pdf
Recommended Citation: Cogswell, Heather, Catherine Connor,Tesfaye Dereje,Avril Kaplan, and
Sharon Nakhimovsky. September 2013. System of Health Accounts 2011What is SHA 2011 and How Are
SHA 2011 Data Produced and Used?. Bethesda, MD: Health Finance & Governance project,
Abt Associates Inc.
Benefits of the Updated Framework - SHA 2011
Updating the SHA has benefited the health resource tracking community in many
important ways:
Improvements in Data Quality: Clarifying boundaries that NHA practitioners
identified as confusing allows for greater accuracy in the tracking of expenditures. For
example, Family Planning had an unclear boundary between prevention and curative
care, which often resulted in pre- and postnatal care being considered as curative
outpatient by some and as prevention for Maternal and Child Health by others. SHA
2011 clarified the boundary by creating a new prevention category, Healthy Condition
Monitoring Programs (HC.6.4) and clearly identified pre- and postnatal care as part of
this category.
Ability to Reflect Financing Mechanisms: the addition of the Health Financing
Schemes dimension has made SHA 2011 better able to reflect growing interest in and
complexity of financing mechanisms that characterize countries’ health systems.
Linked to Other International Classifications: SHA 2011 also ensures that the
SHA is consistent with other international classifications such as ICD-10 classifications
and the International Standard Industry Classification.
More Comprehensive: SHA 2011 has given countries a larger toolbox to use when
conducting estimations. For example, the extension dimensions were added (see
Table 2) as well as instructions for tracking imports and exports and adjusting data for
inflation in trend analysis.
Acknowledgements
The authors would like to acknowledge and thank the Health Accounts team atWHO for providing
their careful review and feedback to this brief.